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NPI Code Detail

MEDICARE: THE INTERNAL MEDICINE GROUP PA

MEDICARE: THE INTERNAL MEDICINE GROUP PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianKS

General Provider Information

NPI Number : 1235136714
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE INTERNAL MEDICINE GROUP PA
Provider Business Mailing Address
First Line : 4525 W 6TH ST STE 100
Second Line :
City : LAWRENCE
State : KS
Zip : 66049-7700
Country : US
Telephone Number : 785-843-5160
Fax Number :
Provider Business Practice Location Address
First Line : 4525 W 6TH ST STE 100
Second Line :
City : LAWRENCE
State : KS
Zip : 66049-7700
Country : US
Telephone Number : 785-843-5160
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. MARY ANN ICE
Credential :
Telephone Number : 785-843-5160
Provider Enumeration Date : 06/30/2005
Last Update Date : 08/14/2007

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Directions to “THE INTERNAL MEDICINE GROUP PA ” Practice Location

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